- MeSH
- Joint Dislocations diagnosis complications therapy MeSH
- Humeral Fractures diagnostic imaging complications therapy MeSH
- Ulna Fractures diagnostic imaging complications therapy MeSH
- Elbow Fractures * diagnostic imaging complications therapy MeSH
- Radius Fractures diagnostic imaging complications therapy MeSH
- Humans MeSH
- Elbow Joint surgery diagnostic imaging pathology MeSH
- Orthopedic Procedures methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
x
x
- MeSH
- Arthrography MeSH
- Arthroscopy MeSH
- Scaphoid Bone injuries MeSH
- Adult MeSH
- Radius Fractures diagnostic imaging complications MeSH
- Humans MeSH
- Joint Instability diagnosis etiology rehabilitation MeSH
- Lunate Bone injuries MeSH
- Wrist Injuries * diagnosis complications MeSH
- Radiography MeSH
- Retrospective Studies MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
PURPOSE OF THE STUDY Radial head fractures in paediatric patients account for 5-19% of all elbow injuries and approximately 1% of all fractures in children. Non-displaced fractures are treated with plaster cast fixation. If the fracture is displaced, we proceed to closed reduction, or to osteosynthesis in case of unstable fragments. If closed reduction fails, we opt for open reduction and osteosynthesis. The prospective randomised clinical study aims to compare the two methods of minimally invasive osteosynthesis using the pre-bent Kirschner wire or Prévot nail and to identify differences between them. MATERIAL AND METHODS The prospective randomised clinical study was conducted in 2015-2019. The final cohort included 32 patients who met the inclusion criteria. The patients in whom other osteosynthesis implants had been used or in whom open reduction had to be performed were excluded from the study. Also excluded were the patients with serious concomitant injuries of elbow. For patients included in the cohort, demographic data, precise evaluation of the displacement and location of the fracture as well as the duration of plaster cast fixation and osteosynthesis implants used were recorded. In the clinical part, the methods were compared based on the achievement of full range of motion in dependence on the degree of original displacement, use of osteosynthesis implant, and occurrence of early and delayed complications. Clinical and radiological outcomes were compared. In both types of minimally invasive osteosynthesis, Métaizeau surgical technique was used. RESULTS Based on the clinical trial criteria, 26 (81%) excellent, 4 (13%) good and 2 (6%) acceptable outcomes were achieved. In 3 cases the loss of rotation was up to 20°, in 1 case the loss of flexion was up to 10°. In one patient the loss of flexion was 15° and rotation up to 30°. In another patient the loss of rotation was up to 40°. The radiological assessment showed 14 (44%) excellent outcomes, 15 good (47%) and 3 (9%) acceptable outcomes. The statistical analysis of both the groups of the cohort using non-parametric tests revealed no statistically significant differences in individual demographic parameters. The comparisons of both types of osteosynthesis in dependence on the degree of displacement by non-parametric Fisher's exact test showed no statistically significant difference in the radiologic or clinical results. The only statistically significant difference was observed in the duration of metal implant placement. DISCUSSION Comparable studies report excellent or good clinical outcomes in 80-95% of cases (1,13,16). In our cohort, excellent or good clinical outcomes were achieved in 30 patients (94%). In two patients, in whom Prévot nail was used, the outcomes were acceptable. Nonetheless, this fact did not result in any statistical significance when comparing the two methods separately or in comparisons based on the degree of displacement. CONCLUSIONS The comparison of the two methods of minimally invasive osteosynthesis revealed no statistically significant difference, namely not even when both the methods were compared based on the degree of displacement. When Kirschner wire is used, the possibility to remove the metal implant in the outpatient setting is considered to be an advantage. The drawback consists in potential penetration of the sharp Kirschner wire in the radiocapitellar joint, which we did not encounter when the second technique of osteosynthesis was used. The advantage of Prévot nail includes a lower risk of pin-tract infection. Key words: minimally invasive osteosynthesis, radial head, fracture, child.
- MeSH
- Child MeSH
- Radius Fractures * diagnostic imaging etiology surgery MeSH
- Bone Wires MeSH
- Humans MeSH
- Prospective Studies MeSH
- Radius injuries MeSH
- Fracture Fixation, Internal * methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
Even though the die-punch fragment of the distal radius fracture was described as early as in 1962, its detection may be crucial to select the optimal therapy even nowadays. Typically, the die-punch fragment is located in the lunate fossa. It can, however, also be located in the radial column. The patient with the die-punch fracture of the scaphoid fossa, treated by us with open reduction and plate osteosynthesis from two surgical approaches, is presented in our case report. Key words: die-punch fracture, distal radius, surgical treatment.
- MeSH
- Radius Fractures * diagnostic imaging surgery MeSH
- Carpal Bones * MeSH
- Bone Plates MeSH
- Humans MeSH
- Radius diagnostic imaging surgery MeSH
- Fracture Fixation, Internal MeSH
- Wrist Joint MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- MeSH
- Arthralgia epidemiology etiology classification MeSH
- Colles' Fracture * surgery diagnostic imaging complications MeSH
- Adult MeSH
- Radius Fractures * surgery diagnostic imaging complications MeSH
- Fracture Healing MeSH
- Middle Aged MeSH
- Humans MeSH
- Longitudinal Studies MeSH
- Young Adult MeSH
- Osteoarthritis epidemiology classification MeSH
- Surveys and Questionnaires MeSH
- Range of Motion, Articular MeSH
- Hand Strength MeSH
- Wrist Joint MeSH
- Hand Deformities, Acquired diagnostic imaging epidemiology etiology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- MeSH
- Colles' Fracture surgery diagnostic imaging complications MeSH
- Adult MeSH
- Radius Fractures * surgery diagnostic imaging complications MeSH
- Humans MeSH
- Osteotomy methods MeSH
- Surgical Clearance methods instrumentation MeSH
- Radiography, Dual-Energy Scanned Projection MeSH
- Treatment Outcome MeSH
- Hand Deformities, Acquired surgery diagnostic imaging MeSH
- Imaging, Three-Dimensional MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- MeSH
- Colles' Fracture * surgery diagnostic imaging complications MeSH
- Diaphyses abnormalities surgery diagnostic imaging MeSH
- Adult MeSH
- Radius Fractures surgery diagnostic imaging complications MeSH
- Humans MeSH
- Osteotomy methods MeSH
- Tomography, X-Ray Computed methods instrumentation MeSH
- Pronation MeSH
- Range of Motion, Articular MeSH
- Supination MeSH
- Ulna abnormalities surgery diagnostic imaging MeSH
- Hand Deformities, Acquired surgery diagnostic imaging MeSH
- Imaging, Three-Dimensional MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Joint Dislocations surgery diagnostic imaging MeSH
- Radius Fractures * surgery diagnostic imaging etiology MeSH
- Humans MeSH
- Reoperation methods MeSH
- Bone-Patellar Tendon-Bone Grafting methods MeSH
- Fractures, Comminuted surgery diagnostic imaging MeSH
- Treatment Outcome MeSH
- Plastic Surgery Procedures MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
Úvod: Zlomeniny distálního radia tvoří 17 % všech zlomenin lidského těla a 75 % zlomenin předloktí. Dříve byly považovány za zlomeniny staršího věku v důsledku osteoporotického postižení kosti. V současné době se s rozvojem některých sportů a motorismu vyskytují stále častěji u mladších jedinců. Materiál a metodika: V letech 2014-2015 bylo na pracovištích autorů odoperováno s použitím volární LCP dlahy celkem 54 pacientů. Ke kontrolnímu vyšetření se dostavilo celkem 45 pacientů ve věku 29-72 roků. Průměrný věk byl 48,6 roku. Mužů bylo operováno celkem 24 (54 %) a 21 (46 %) žen. Dominantní končetina byla poraněna u 27 jedinců (60 %) a nedominantní u 18 (40 %). Pacienti byli zhodnoceni rok po úrazu a bylo provedeno rtg vyšetření, kde bylo zhodnoceno zhojení, změny v souvislosti s užitým implantátem či chybou operatérů. Klinické vyšetření bylo provedeno podle DASH skóre. Výsledky: Při hodnocení funkčních výsledků podle DASH skóre samoobslužné činnosti bylo průměrné hodnocení 28,8 bodu, kdy nejlepší bylo 0 bodů a nejhorší 39 bodů (medián 14,17 bodů). Nejhorší tři (7 %) výsledky byly pozorovány u pacientů, kde již před operací byly patrné degenerativní změny typu SLAC II-III, které měly i podíl na následných horších výsledcích hodnocení. U dvou (4 %) s horšími klinickými obtížemi byly zjištěny známky risartrózy. Pokud jsme hodnotili další poranění jak na rtg snímcích, tak během operace, byla prokázána totální ruptura skafolunátního vazu u 2 (4 %) pacientů, vazy distálního radioulnárního kloubu u 6 (12 %) pacientů a processus styloideus radii byl poškozen u 16 (35 %) pacientů. Při hodnocení komplikací byl u jedné pacientky (2 %) diagnostikován komplexní regionální bolestivý syndrom a u jednoho pacienta ruptura musculus extensor pollicis longus (2 %), což bylo řešeno transpozicí šlachou musculus extensor indicis proprius. Komplikace s hojením jsme nezaznamenali. Při hodnocení rtg snímků bylo konstatováno, že došlo ve všech případech ke zhojení zlomeniny a nebyly pozorovány jakékoli patologické změny ve vztahu k implantátu. Diskuze: Na dobrý výsledek při ošetření zlomeniny distálního radia má vliv správná indikace k osteosyntéze, dodržení všech zásad repozice zlomeniny, kdy je důležitá repozice kloubních ploch jak v radiokarpálním, tak v distálním radioulnárním kloubu, dodržení správného sklonu kloubních ploch jak v sagitální, tak frontální rovině a dodržení správné vzájemné délky radia a ulny. Důležitá je diagnostika dalších přidružených vazivových poranění a jejich ošetření. Závěr: Zlomeniny distálního radia jsou častá poranění, ale stále nedodržení zásad správného ošetření vede k neuspokojivým výsledkům. Jen aktivní přístup s použitím moderních implantátů a dodržení správných indikací a operační techniky vedou k dobrým výsledkům.
Introduction: Fractures of the distal radius account for 17% of all fractures of the human body and 75% of the forearm fractures. Previously, they were considered to be fractures typical for older age, due to osteoporotic bone involvement. The current popularity of certain sports and motor vehicles leads to these fractures being more frequent in younger individuals. Material and Methods: In the years 2014-2015, 54 patients were treated at the workplace of the authors using the LCP plate. A total of 45 patients aged 29-72 years presented themselves for a check-up. The mean age was 48.6 years. A total of 24 (54%) and 21 (46%) women were operated. Dominant limb was injured in 27 individuals (60%) and non-dominant in 18 (40%). The patients were evaluated one year after the injury, and an X-ray examination was performed where healing, implantation changes, or surgeon errors were evaluated. The clinical examination was performed according to the DASH score. Results: When evaluating DASH performance scores for self-service activity, the average score was 28.8, with the best score at 0 points and the worst score at 39 points (median 14.17 points). The worst three (7%) results were seen in patients with degenerative SLAC II-III changes before the surgery, which also contributed to subsequent worse results. In two cases, with significant clinical difficulties, signs of risartrosis were found. We evaluated further injuries in both RTG frames and total scaphoid ligament rupture in 2% (4%) patients, radial ligament ligaments in 6 (12%) patients and processus styloideus radius were damaged in 16 (24%) patients. In cases of complications, a complex regional syndrome was diagnosed in one patient (2%) and a rupture of musculus extensor pollicis longus (2%) in one patient, which was solved by translocation with the tendon musculus extensor indicis proprius. We did not notice complications with healing. RTG imaging was judged to have occurred in all cases for fracture healing and no pathological changes were observed in relation to the implant. Discussion: A good result in the treatment of the distal radius fracture is predicated on correct indication of osteosynthesis, observance of all principles of fracture repositioning, where it is important to reposition the articular surfaces in both the radiocarpal and distal radial joints, to maintain the correct inclination of the articular surfaces both in the sagittal and frontal plane and to adhere to the correct the length of the radius and the ulna. It is important to diagnose and treat other associated connective tissue injuries. Conclusion: Fractures of the distal radius are frequent injuries, but non-compliance with the principles of proper treatment stull leads to unsatisfactory results. Only an active approach using modern implants and adherence to proper indications and operational techniques will lead to satisfactory results.
- Keywords
- volární LCP dlahy, zlomeniny distálního radia,
- MeSH
- Splints * MeSH
- Adult MeSH
- Radius Fractures * diagnostic imaging surgery MeSH
- Fracture Healing MeSH
- Bone Screws MeSH
- Middle Aged MeSH
- Humans MeSH
- Recovery of Function MeSH
- Postoperative Complications MeSH
- Wrist Injuries surgery MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Fracture Fixation, Internal * MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
